Director of Coding-CDI-HIM

About the role

Provides strategic leadership and oversight for revenue cycle operations related to coding, clinical documentation, and health information management across Nebraska Methodist Hospital. Responsible for Clinical Documentation Improvement (CDI), Utilization Management, Tumor Registry, Health Information Management (HIM), and Transcription Services, ensuring regulatory compliance, operational efficiency, and the integrity of the legal medical record.

Responsibilities

• Directs coding for Nebraska Methodist Hospitals and hospital-based outpatient clinics (System Wide) (35%)
  • Manages internal and external coding resources to ensure the timely, accurate, and compliant assignment of diagnoses and procedures, supporting appropriate severity of illness and intensity of service capture.
  • Oversees concurrent coding activities in partnership with the Clinical Documentation Improvement (CDI) team to enhance documentation accuracy and optimize reimbursement.
  • Directs the administration, maintenance, and optimization of coding software, encoders, computer-assisted coding (CAC) tools, and related system applications.
  • Establishes and monitors coding quality and productivity standards, ensuring staff performance meets or exceeds organizational expectations.
  • Ensures coding compliance through ongoing monitoring, education, and periodic internal and external audits, implementing corrective actions as needed.
  • Leverages advanced coding technologies and automation tools to improve coding accuracy, completeness, efficiency, and regulatory compliance.
  • Oversees the full lifecycle of Recovery Audit Contractor (RAC) and Targeted Probe and Educate (TPE) audits, including audit tracking, documentation collection, response preparation, coordination with clinical and revenue cycle teams, appeal support, and adherence to CMS requirements and submission deadlines.
• Provides leadership and oversight of the Clinical Documentation Improvement (CDI) program, ensuring completion of daily concurrent and follow-up reviews, timely physician query resolution, ongoing provider education, and collaboration with coding staff to support accurate DRG assignment and reimbursement.
  • Builds and maintains a high-performing CDI team capable of effectively engaging physicians and other clinical practitioners to improve documentation quality and accuracy.
  • Develops and delivers physician education initiatives to ensure clinical documentation accurately reflects patient acuity, severity of illness, risk of mortality, quality outcomes, and resource utilization.
  • Oversees staff training, competency development, quality assurance reviews, and onboarding/orientation programs for new physicians and clinical practitioners related to documentation and coding best practices.
  • Champions industry best practices in clinical documentation integrity, promoting accurate and complete capture of patient care that supports compliant coding, quality reporting, and reimbursement outcomes.
  • Analyzes and monitors key performance indicators, including case mix index (CMI), severity of illness (SOI), risk of mortality (ROM), and CC/MCC capture rates, identifying trends and opportunities for targeted physician and coder education and process improvement.
• Oversees Utilization Management for hospitals (20%)
  • Provides leadership and oversight of utilization management processes to ensure timely acquisition and extension of payer authorizations, supporting appropriate reimbursement and continuity of care.
  • Collaborates with commercial, government, and other third-party payers to facilitate authorization approvals, resolve coverage issues, and ensure compliance with payer requirements.
  • Oversees the provision of clinical review information that accurately reflects the patient's condition, treatment plan, level of care, and medical necessity to support authorization and reimbursement decisions.
  • Promotes collaboration with clinical, case management, and revenue cycle teams to optimize utilization review practices, minimize authorization denials, and improve financial and operational outcomes.
• Schedule Full time
• Job Requirements
• Education Requires Bachelor's degree in Nursing, Health Information Management or Healthcare related field. Master's degree preferred.
• Experience Minimum of 7-10 years progressive experience in hospital/health care setting. Minimum of 10 years of management experience. Recent experience in a hospital, health system or large multi-specialty physician group setting. Demonstrated track record of mentoring teams resulting in higher level of job satisfaction and performance. Minimum 5 years' experience managing different components of the Revenue Cycle preferred.
• Licenses/Certifications Current valid Registered Nurse (RN) license, valid compact multistate license, or a temporary permit while awaiting licensure required. Or Certified as a Registered Health Information Administrator (RHIA) required.
• Skills/Knowledge/Abilities Knowledge of rules and regulations regarding registration, the legal medical record and release of information. Proficient DRG, ICD-10, CPT-4 medical record coding, UB04/CMS-1500 claim billing. Knowledge of revenue cycle accounting concepts. Proficiency in Health Information Systems, coding technology, and various other system applications related to coding and clinical documentation. Ability to work independently. Ability to effectively manage uncertainty and complex situations. Ability to motivate a high performing team. Demonstrates a sense of urgency. Ability to identify, analyze and effectively address complex issues. Ability to establish positive working relationship with a variety of departments/individuals and promote collaboration. Position requires a strong positive working relationship with medical staff.

Qualifications

• Weight Demands Light Work - Exerting up to 20 pounds of force. Physical Activity Not necessary for the position (0%): Balancing Carrying Climbing Crawling Crouching Kneeling Lifting Pulling/Pushing Standing Stooping/bending Twisting Occasionally Performed (1%-33%): Distinguish colors Grasping Walking Frequently Performed (34%-66%): Keyboarding/typing Reaching Repetitive Motions Sitting Speaking/talking Constantly Performed (67%-100%): Hearing Seeing/Visual

Benefits

Most importantly, our employees are part of a team that makes a real difference in the communities we live and work in. Nebraska Methodist Health System is an Affirmative Action/Equal Opportunity Employer and does not discriminate on the basis of race, color, religion, sex, age, national origin, disability, veteran status, sexual orientation, gender identity, or any other classification protected by Federal, state or local law.